LSU Health Digital Scholar (Louisiana State Univ.)
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Mental health status and quality of life is not improved in amputees following targeted muscle reinnervation
No full textIntroduction: Targeted muscle reinnervation (TMR) in amputee patients is a surgical intervention that has shown promise in improving pain and functional outcomes. However, limited research exists regarding its effects on midterm mental health and the quality of life in amputees. Methods: A chart review was conducted for 46 patients (53 limbs) who underwent TMR. Patients were contacted after at least 1 year and assessed for mental health and quality of life using standardized patient-reported outcome measures (PROMs), including the patient health questionnaire-9 (PHQ-9), posttraumatic stress disorder (PTSD) checklist-specific (PCL-S), Nottingham health profile (NHP), and quality of life scale (QOLS). Data were analyzed using t-tests and linear regression models. Results: Patients reported significant improvements in residual limb pain, with median preoperative numerical rating scale (NRS) scores of 8 improving to 1 post-operatively (p \u3c 0.05). Mental health PROMs were administered at a mean of 693.6 + 411.6 days following TMR. Mean PHQ-9, PCL-S, NHP, and QOLS scores were 7.5 ± 5.6, 32.6 ± 13.2, 39.1 ± 26.3, and 74.4 ± 21.1, respectively. There was a high prevalence of mental health disorders, with 55% of the patients exhibiting PHQ-9 scores indicating mild depression, while 25% screened positive for PTSD. Linear regression showed a significant positive correlation (p \u3c 0.05) between post-operative NRS and PHQ-9 (depression) scores. Conclusion: Although TMR effectively reduces residual pain in amputees, its effect on mental health and quality of life is limited. High rates of depression and PTSD remain prevalent in this population. High NRS scores correlate with increased depression scores
Out of Touch: A Nationwide Mixed-Methods e-Learning Needs Assessment of General Surgery Residents
No full textIntroduction: The digital age has transformed health professions education, making online learning (e-learning) essential for instruction, assessment, and evaluation. However, general surgery residents are dissatisfied with current study methods and routines. As they progress through the new Entrustable Professional Activities (EPA) milestones, adapting content delivery to their learning preferences is crucial for engagement, a key element in the Kirkpatrick training evaluation model. This study explores general surgery residents\u27 experiences, attitudes, and preferences toward e-learning to enhance instruction in the EPA era of surgical education. Methods: We used a convergent parallel design, distributing a national survey and conducting semi-structured interviews with general surgery residents from 22 U.S. institutions. The survey examined e-learning resource utilization, satisfaction, and financial investment in medical school and residency. Interviews provided insights into residents\u27 desired features of effective e-learning. Data analysis included comparative statistics for survey results and reflexive thematic analysis for interviews. Results: The survey was completed by 106 general surgery residents. Residents reported higher satisfaction with e-learning resources utilized in medical school (e.g., UWorld, Sketchy Medical) than those in residency (e.g., TrueLearn, SCORE Web Portal) (mean difference = 0.4, 95% CI = [0.3,0.5], p \u3c 0.001). Learners’ financial investment in USMLE preparation was significantly higher than for ABSITE (74% vs. 21% willing to spend \u3e $500; p \u3c 0.001). Separately, 30 general surgery residents participated in semi-structured interviews, which highlighted preferences for mobile learning, multimedia, gamification, and competency-based assessments. Residents noted a gap between current e-learning resources and the EPA assessment paradigm. Conclusions: General surgery residents find current e-learning resources in residency lacking clinical relevance and alignment with competency-based assessments. In the EPA era of surgical education, there is a need to develop innovative e-learning platforms that prepare residents for standardized examinations and support clinical competency development. Addressing these gaps will enhance the quality and efficiency of surgical training to better prepare residents for independent practice
Cyclin-dependent kinase 4 and 6 inhibitors in breast cancer treatment
No full textBreast cancer is the second largest cancer in the world, and it has highest mortality rate in women worldwide. The aberrant activation of the cyclin-dependent kinase 4 and 6 (CDK4/6) pathway plays an important role in uncontrolled breast cancer cell proliferation. Therefore, targeting CDK4/6 to improve overall survival rates has been a strong interest in breast cancer therapeutics. Till date, four CDK4/6 inhibitors have been developed and approved for hormone receptor-positive and human epidermal growth factor receptor 2 (HER2)-negative metastatic breast cancer therapies with great success. However, acquired resistance to CDK4/6 inhibitors has emerged and limits their effectiveness in breast cancer. In this review, we systematically discussed the mechanisms of resistance to CDK4/6 inhibitors including the cell cycle-specific and cell cycle-nonspecific mechanisms. Also, we analyzed combination strategies with other signaling inhibitors in clinical and preclinical settings that further expand the clinical application of CDK4/6 inhibitors in future breast cancer therapies
Practical Atlas of Ultrasound for Anesthesia in Chronic Pain
No full textTraditionally, administering local anesthesia to the peripheral nerves was performed using anatomical structures to identify the nerves; however, using ultrasound guidance in regional anesthesia has made nerve blocks safer. Ultrasound-guided nerve blocks provide clearer visualization of the needle, the local anesthetic, as well as the nerves and surrounding anatomical landmarks [1, 2]. One such form of an ultrasound-guided nerve block is a radial nerve block, which provides anesthesia to the dorsal radial side of the forearm and hand. Radial nerve blocks are most commonly used for fracture reductions in emergency settings [3]. In documented cases where a radial nerve block was performed for surgical procedures, prior attempts to perform a proximal upper extremity block failed or were incomplete [2, 3]. Currently, ultrasound-guided radial nerve blocks prove to be safer and more effective in providing surgical anesthesia and local anesthesia with the reduced risks that are typically accompanied by using general anesthesia [1-3]
The bone marrow endothelial progenitor cell response to septic infection: Dataset
No full textAn early increase in the level of endothelial progenitor cells (EPCs) in the systemic circulation occurs in patients with septic infection/sepsis. The significance and underlying mechanisms of this response remain unclear. This study investigated the bone marrow EPC response in adult mice with septic infection induced by intravenous injection (i.v.) of Escherichia coli. For in vitro experiments, sorted marrow stem/progenitor cells (SPCs) including lineage(lin)-stem cell growth factor receptor(c-kit)+stem cell antigen-1(Sca-1)-, lin-c-kit+, and lin- cells were cultured with or without lipopolysaccharides (LPS) and recombinant murine vascular endothelial growth factor (VEGF) in the absence and presence of anti-Sca-1 crosslinking antibodies. In a separate set of experiments, marrow lin-c-kit+ cells from green fluorescence protein (GFP)+ mice, i.v. challenged with heat-inactivated E. coli or saline for 24 h were subcutaneously implanted in Matrigel plugs for 5 weeks. Marrow lin-c-kit+ cells from Sca-1 knockout (KO) mice challenged with heat-inactivated E. coli for 24 h were cultured in the Matrigel medium for 8 weeks. The marrow pool of EPCs bearing the lin-c-kit+Sca-1+VEGF receptor 2 (VEGFR2)+ (LKS VEGFR2+) and LKS CD133+VEGFR2+ surface markers expanded rapidly following septic infection, which was supported by both proliferative activation and phenotypic conversion of marrow stem/progenitor cells. An increase in marrow EPCs and their reprogramming for enhancing angiogenic activity correlated with cell-marked upregulation of Sca-1 expression. Sca-1 coupled with ras-related C3 botulinum toxin substrate 2 (Rac2) in signaling the marrow EPC response. Septic infection caused a substantial increase in plasma levels of IFN-γ, VEGF, G-CSF, and SDF-1. The early increase in circulating EPCs was accompanied by their active homing and incorporation into pulmonary microvasculature. These results demonstrate that the marrow EPC response is a critical component of the host defense system. Sca-1 signaling plays a pivotal role in the regulation of EPC response in mice with septic infection
